Dennis Peron, who openly dealt marijuana from a “supermarket” in San Francisco in the 1970s before leading a successful campaign to legalize it for medical use in California two decades later, died on Saturday at a San Francisco hospital. He was 71.

John Entwistle Jr., his spouse, said the cause was respiratory failure.

Mr. Peron was identified with marijuana all his adult life.

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He began smoking it at 17. He continued in Vietnam, where he served in the US Air Force, and smuggled 2 pounds stateside in his duffel bag after his discharge. “I came back and kissed the ground,” he told Leafly.com, an online cannabis website, in 2014. “I was happy — partly because I had two pounds with me. That started a career that would span 40 years.”

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Short, puckish, and charismatic, Mr. Peron embraced the hippie lifestyle in San Francisco, living in a commune, dealing and smoking marijuana, and opening a restaurant where the second floor was given over to selling it. He was arrested several times; during one bust, at his 11-room supermarket on Castro Street, he was shot in the leg by an undercover police officer. A prison sentence for possessing 200 pounds of marijuana ensued.

But it took the AIDS crisis to turn Mr. Peron into a political activist.

He had known for years about the palliative effects of marijuana. He also recognized that pot had allowed him to stay sober after years as an alcoholic. When an earlier lover, Jonathan West, was dying of AIDS, he saw how marijuana eased the nausea and pain West felt from the medications he was taking.

One night in January 1990, the police raided their home, arrested Mr. Peron and charged him with possessing marijuana with intent to sell.

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“Now, I’ve sold marijuana in my life — lots of it, but I was not selling that night,” Mr. Peron wrote, with Entwistle, in his autobiography, “Memoirs of Dennis Peron: How a Gay Hippy Outlaw Legalized Marijuana in Response to the AIDS Crisis” (2012).

At Mr. Peron’s trial six months later, West testified that the pot was his, and the charges against Mr. Peron were dropped.

Two weeks after that, West died and Mr. Peron had his cause: to change the laws that criminalized the possession of marijuana for medical use. He joined with other activists to write a ballot initiative, Proposition P, which asked the city of San Francisco to recommend that California add marijuana to its list of approved medicines to treat various illnesses — including AIDS, glaucoma, cancer and multiple sclerosis — and not penalize doctors who prescribed it.

The initiative passed overwhelmingly in 1991; the next year, the San Francisco Board of Supervisors adopted a resolution urging the police and the district attorney to make the arrest and prosecution of those growing or possessing pot for medical purposes the “lowest priority.”

While lobbying for statewide medical marijuana legislation, Mr. Peron opened the San Francisco Cannabis Buyers’ Club, a medical dispensary. Initially intended for AIDS and cancer patients, it soon accepted a broader universe of the seriously ill.

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As Californians appeared close to legalizing medical marijuana in 1996 through Proposition 215, which Mr. Peron helped write, he faced legal obstacles. In August that year, state narcotics agents raided and closed his dispensary, seizing 40 pounds of marijuana; that October, Mr. Peron was arrested and indicted in Oakland for criminal conspiracy and possession of marijuana.

His supporters criticized the California attorney general, Dan Lungren, an opponent of Proposition 215, calling his actions politically motivated attacks. Proposition 15 easily passed, with more than 5.3 million votes to 4.3 million in opposition.

Dennis Robert Peron was born in the Bronx on April 8, 1946. His father, Albert, was a computer programmer for Nassau County, New York, and his mother, the former Mary McGrath, was a homemaker.

Mr. Peron’s health deteriorated in recent years; he was found to have lung damage from exposure to Agent Orange in Vietnam as well as emphysema, lung cancer, and chronic obstructive pulmonary disease.

In addition to Entwistle, Mr. Peron is survived by his brothers, Brian and Jeffrey.

In 2016, California voters approved Proposition 64, legalizing recreational marijuana in California. Mr. Peron had campaigned against it, arguing that it would hurt local farmers in favor of big businesses and make it easier to arrest and prosecute people.